MERCER: Did SD miss chance to expand Medicaid eligibility?

The members now concentrate on ways state government can shift a greater share of financial responsibility for tribal health care back to the federal government.

But interest from tribal participants seems to be fading even for some of those possibilities.

Minutes from the Oct. 7, 2015 meeting summarized the coalition's original purpose.

"The group will focus on development of a solution that supports increased access to health care for Native Americans while leveraging general fund savings to fund expansion in the long term, and to improve health outcomes for Native Americans in South Dakota."

That's how Gov. Dennis Daugaard would have accepted paying state costs for expanding Medicaid eligibility. Thousands of working adults with incomes just above federal poverty could have coverage equal to poorer neighbors.

The Republican governor's hope was reducing current state payments for tribal patients' healthcare outside the federal Indian Health Service system.

The savings in turn could apply to subsidize Medicaid expansion.

The coalition members eventually realized savings weren't enough to cover expansion.

So Republican legislators on the coalition decided Medicaid expansion should be set to the side.

They concluded the governor was right: State government couldn't afford to subsidize expansion.

But voters in Maine on Tuesday did something never before done in the United States of America.

They decided, 59 percent to 41 percent, in a statewide referendum, that Medicaid eligibility should be expanded.

The New York Times reported the results as 202,616 voting yes and 141,222 voting no with 99 percent of precincts counted. Places with higher populations, including the 30 biggest, favored expansion, while small places split.

Maine's legislators had tried to expand eligibility, only to be overruled by their Republican governor, Paul LePage.

Whether LePage would ultimately comply wasn't clear as of this writing. Whatever other differences, LePage and Daugaard stood together against paying more for Medicaid expansion.

The question that popped up Wednesday after Maine's voters approved expansion was whether South Dakota voters missed their chance.

South Dakota's deadline was Monday, Nov. 6, for petition sponsors to submit signatures for initiated laws and constitutional amendments proposed for the November 2018 statewide ballot.

The next step, already under way, is Secretary of State Shantel Krebs determining which measures have sufficient valid signatures to qualify.

Medicaid expansion isn't among them.

The Legislature could offer in the 2018 session a constitutional amendment on expansion that would automatically be on the 2018 ballot.

Lawmakers could do it without the governor's say. It would come in Daugaard's last year as governor.

Otherwise it's wait until 2019 for petition sponsors to propose Medicaid expansion for the 2020 general election.

Or South Dakota could let the matter sit.

With the federal debt already giant, doing nothing could be the South Dakota way of doing something, refusing to spend the federal government into an even deeper hole.